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Meier-Diedrich E, Neumann K, Heinze M, Schwarz J. [Attitudes and Expectations of Psychological and Medical Psychotherapists Towards Open Notes: Analysis of Qualitative Survey Responses]. PSYCHIATRISCHE PRAXIS 2024; 51:376-384. [PMID: 38810902 DOI: 10.1055/a-2320-8929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE This study explores attitudes and expectations of psychotherapists (PT) towards the introduction of digital patient access to clinical notes ("Open Notes"; ON)), including the advantages and disadvantages in psychotherapeutic practice. METHODS As part of the PEPPPSY study, an online survey was conducted. Free text responses (n = 107) were qualitatively analysed using thematic analysis. RESULTS 129 psychological and medical PT took part in the survey. PT saw advantages such as transparency and patient-centred documentation, but feared disadvantages for the therapeutic relationship and an increased workload through the implementation of ON. Concerns were raised about data security and negative effects on treatment. Recommendations for implementation include patient-specific access adaptations and guided access. CONCLUSION PT are ambivalent about ON. Further research and guidelines for the use of ON in psychotherapy are needed.
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Affiliation(s)
- Eva Meier-Diedrich
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Seelische Gesundheit, Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin
| | | | - Martin Heinze
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Seelische Gesundheit, Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf
| | - Julian Schwarz
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Seelische Gesundheit, Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf
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Holt G, Zabinski J. Amend Notes as the Next Frontier of the OpenNotes Initiative. J Gen Intern Med 2024; 39:2578-2580. [PMID: 38943016 PMCID: PMC11436603 DOI: 10.1007/s11606-024-08904-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/14/2024] [Indexed: 06/30/2024]
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Keuper J, van Tuyl LHD, de Geit E, Rijpkema C, Vis E, Batenburg R, Verheij R. The impact of eHealth use on general practice workload in the pre-COVID-19 era: a systematic review. BMC Health Serv Res 2024; 24:1099. [PMID: 39300456 DOI: 10.1186/s12913-024-11524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 09/02/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND In recent years, eHealth has received much attention as an opportunity to increase efficiency within healthcare organizations. Adoption of eHealth might consequently help to solve perceived health workforce challenges, including labor shortages and increasing workloads among primary care professionals, who serve as the first point of contact for healthcare in many countries. The purpose of this systematic review was to investigate the impact of general eHealth use and specific eHealth services use on general practice workload in the pre-COVID-19 era. METHODS The databases of CINAHL, Cochrane, Embase, IEEE Xplore, Medline ALL, PsycINFO, Web of Science, and Google Scholar were searched, using combinations of keywords including 'eHealth', 'workload', and 'general practice'. Data extraction and quality assessment of the included studies were independently performed by at least two reviewers. Publications were included for the period 2010 - 2020, before the start of the COVID-19 pandemic. RESULTS In total, 208 studies describing the impact of eHealth services use on general practice workload were identified. We found that two eHealth services were mainly investigated within this context, namely electronic health records and digital communication services, and that the largest share of the included studies used a qualitative study design. Overall, a small majority of the studies found that eHealth led to an increase in general practice workload. However, results differed between the various types of eHealth services, as a large share of the studies also reported a reduction or no change in workload. CONCLUSIONS The impact of eHealth services use on general practice workload is ambiguous. While a small majority of the effects indicated that eHealth increased workload in general practice, a large share of the effects also showed that eHealth use reduced workload or had no impact. These results do not imply a definitive conclusion, which underscores the need for further explanatory research. Various factors, including the study setting, system design, and the phase of implementation, may influence this impact and should be taken into account when general practices adopt new eHealth services. STUDY REGISTRATION NUMBER PROSPERO (International Prospective Register of Systematic Reviews) CRD42020199897; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199897 .
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Affiliation(s)
- Jelle Keuper
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands.
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, Netherlands.
| | - Lilian H D van Tuyl
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
| | - Ellemarijn de Geit
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
| | - Corinne Rijpkema
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, Netherlands
| | - Elize Vis
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
- Department of Sociology, Radboud University Nijmegen, Thomas van Aquinostraat 4, Nijmegen, 6525GD, Netherlands
| | - Robert Verheij
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, Netherlands
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Abel G, Atherton H, Sussex J, Akter N, Aminu AQ, Bak W, Bryce C, Clark CE, Cockcroft E, Evans H, Gkousis E, Jenkins G, Jenkinson C, Khan N, Lambert J, Leach B, Marriott C, Newbould J, Parkinson S, Parsons J, Pitchforth E, Sheard L, Stockwell S, Thomas C, Treadgold B, Winder R, Campbell JL. Current experience and future potential of facilitating access to digital NHS primary care services in England: the Di-Facto mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-197. [PMID: 39324475 DOI: 10.3310/jkyt5803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Background Current National Health Service policy in England encourages enhanced digital access in primary care service provision. In this study, we investigate 'digital facilitation' - that range of processes, procedures and personnel which seeks to support National Health Service primary care patients in their uptake and use of online services. Objectives Identify, characterise and explore the potential benefits and challenges associated with different models of digital facilitation currently in use in general practice which are aimed at improving patient access to online services in general practice in England. Use the resulting intelligence to design a framework for future evaluations of the effectiveness and cost effectiveness of such interventions. Explore how patients with mental health conditions experience digital facilitation and gauge their need for this support. Design Observational mixed-methods study (literature review, surveys, ethnographic observation and interviews); formal synthesis of findings. Setting General practice in four regions of England. Participants Practice survey: 156 staff. Patient survey: 3051 patients. Mental health survey: 756 patients. General practitioner patient survey: 3 million responders. Ethnographic case-studies: 8 practices; interviews with 36 staff, 33 patients and 10 patients with a mental health condition. Stakeholder interviews: 19 participants. Intervention Digital facilitation as undertaken in general practice. Main outcome measures Patient and practice staff reported use of, and views of, digital facilitation. Data sources Surveys, qualitative research; national General Practitioner Patient Survey (2019-22). Review methods Scoping-review methodology applied to academic and grey literature published 2015-20. Results While we did find examples of digital facilitation in routine practice, these often involved using passive or reactive modes of support. The context of COVID, and the necessary acceleration (at that time) of the move to a digital-first model of primary care, shaped the way digital facilitation was delivered. There was lack of clarity over where the responsibility for facilitation efforts lay; it was viewed as the responsibility of 'others'. Patients living with mental health conditions had similar needs and experiences regarding digital facilitation to other patients. Limitations The context of the COVID pandemic placed limitations on the project. Fewer practices responded to the practice survey than anticipated; reconfiguration of general practices to support COVID measures was a key consideration during non-participant observation with social distancing and other measures still in place during fieldwork. Conclusions Digital facilitation, while not a widely recognised concept, is important in supporting the move to a National Health Service with enhanced digital opportunities and enhanced digital access. General practice staff are allocating resources to provide such efforts in general practices in England. The establishment of clear lines of responsibility, the development of digital tools and platforms that work for patients and practice staff, and investment in staff time and training are needed if digital facilitation is to support the intended digital revolution. Future work We did not find one single dominant or preferred model of digital facilitation which might reasonably be considered to form the basis of an intervention to be tested. Rather, there is a need to co-develop such an intervention with patients, general practice staff and relevant policy experts. We outline a framework for a future evaluation of such an intervention. Study registration This study is registered as ResearchRegistry6523 (www.researchregistry.com/browse-the-registry#home/?view_2_search=Di-Facto&view_2_page=1) and PROSPERO CRD42020189019 (www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128268) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 32. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Gary Abel
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibbet Hill, UK
| | - Jon Sussex
- RAND Europe, Westbrook Centre, Cambridge, UK
| | - Nurunnahar Akter
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Abodunrin Q Aminu
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Wiktoria Bak
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Carol Bryce
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibbet Hill, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Emma Cockcroft
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | | | | | - Georgia Jenkins
- PenARC Patient and Public Involvement Team, University of Exeter, Exeter, UK
| | - Caroline Jenkinson
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Nada Khan
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | | | | | - Christine Marriott
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | | | | | - Jo Parsons
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibbet Hill, UK
| | - Emma Pitchforth
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Laura Sheard
- Department of Health Sciences, University of York, York, UK
| | | | - Chloe Thomas
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Bethan Treadgold
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Rachel Winder
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - John L Campbell
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
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Moore C, Adams S, Beatty M, Dharmaraj B, Desai AD, Bartlett L, Culbert E, Cohen E, Stinson JN, Orkin J. Caregiver and Care Team Perceptions of Online Collaborative Care Planning for CMC. Pediatrics 2024; 154:e2024065884. [PMID: 39188252 DOI: 10.1542/peds.2024-065884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Care plans summarize a child with medical complexity's (CMC) medical history and ongoing care needs. Often, the health care team controls the care plan content, limiting caregivers' ability to edit the document in real time and potentially compromising accuracy and utility. With this study, we aimed to provide caregivers of CMC with online access and shared editing control of their child's care plan and to explore the experiences of caregivers and care team members (CTMs) after using an online collaborative care plan (OCCP). METHODS Caregivers of CMC were recruited from a tertiary complex care program to use an online, patient-facing platform for 6 months, which included the ability to edit and share their child's care plan. Caregivers and CTMs participated in semi-structured interviews to explore their experiences in using the OCCP. Consistent with grounded theory methodology, a constant comparative analysis was used, which allowed for theoretical sampling and theory generation. RESULTS A total of 15 caregivers and 20 CTMs completed interviews. Interviews revealed 3 major themes and 9 subthemes, including (1) the navigation of uncharted roles (trust, responsibility), (2) the requirements for success (electronic medical record integration, online access, collaborative care plan review), and (3) cohesive care (accessibility and convenience, being on the same page, autonomy). Themes informed the creation of a theoretical model for the implementation and utility of OCCPs. CONCLUSIONS Online, collaborative care plans, when implemented safely and thoughtfully, promote shared understanding, improve caregiver autonomy, and increase the accessibility of health information. Together, these benefits facilitate cohesive care and authentic partnership between caregivers and CTMs in the care of CMC.
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Affiliation(s)
| | - Sherri Adams
- SickKids Research Institute
- Division of Pediatric Medicine
- Lawrence S Bloomberg Faculty of Nursing
| | - Madison Beatty
- SickKids Research Institute
- Division of Pediatric Medicine
| | | | - Arti D Desai
- University of Washington School of Medicine, Seattle, Washington
| | - Leah Bartlett
- Royal Victoria Regional Health Centre, Barrie, Canada
| | | | - Eyal Cohen
- SickKids Research Institute
- Division of Pediatric Medicine
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Jennifer N Stinson
- SickKids Research Institute
- Department of Anesthesia and Pain Medicine, SickKids, Toronto, Canada
- Lawrence S Bloomberg Faculty of Nursing
| | - Julia Orkin
- SickKids Research Institute
- Division of Pediatric Medicine
- Department of Pediatrics, University of Toronto, Toronto, Canada
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Syed SA, Eth S, Fontenele R, Regan J. Access to Psychotherapy Notes: Review of Legal Standards for Mental Health Clinicians. Am J Psychother 2024:appipsychotherapy20230036. [PMID: 39039924 DOI: 10.1176/appi.psychotherapy.20230036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Patients' access to their psychotherapy records may be assumed to be well protected; however, the matter is intricately regulated. In fact, the statutes and rights pertaining to patient access to psychotherapy notes vary across states. Taken together, federal and state laws indirectly and inconsistently delineate lawful access-as well as clinical exceptions to providing access-to psychotherapy notes. Federal law defers to state laws when the latter afford individuals greater access to their notes. Both federal and individual state levels vary in providing for possible conditions under which access may be restricted. Right of access to psychotherapy notes is a matter of importance for all mental health clinicians in the United States. Awareness and integration of pertinent laws and regulations allow clinicians to manage such matters without a negative impact on their clinical care. Further consideration of how clinical practice interacts with other dimensions of health care administration (clinical, ethical, and legal) may serve to enhance the integrity of a clinician's work and the ability to adapt to difficult clinical circumstances with confidence.
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Affiliation(s)
- Shariful A Syed
- Department of Psychiatry, School of Medicine, Yale University, New Haven, and U.S. Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut (Syed, Fontenele); Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami (Eth); VA Clinical Resource Hub, VA Sunshine Healthcare Network, St. Petersburg, Florida (Regan); North, Pursell & Ramos, PLC, Nashville (Regan)
| | - Spencer Eth
- Department of Psychiatry, School of Medicine, Yale University, New Haven, and U.S. Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut (Syed, Fontenele); Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami (Eth); VA Clinical Resource Hub, VA Sunshine Healthcare Network, St. Petersburg, Florida (Regan); North, Pursell & Ramos, PLC, Nashville (Regan)
| | - Rodrigo Fontenele
- Department of Psychiatry, School of Medicine, Yale University, New Haven, and U.S. Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut (Syed, Fontenele); Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami (Eth); VA Clinical Resource Hub, VA Sunshine Healthcare Network, St. Petersburg, Florida (Regan); North, Pursell & Ramos, PLC, Nashville (Regan)
| | - Judith Regan
- Department of Psychiatry, School of Medicine, Yale University, New Haven, and U.S. Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut (Syed, Fontenele); Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami (Eth); VA Clinical Resource Hub, VA Sunshine Healthcare Network, St. Petersburg, Florida (Regan); North, Pursell & Ramos, PLC, Nashville (Regan)
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Sisk BA, Antes AL, Bereitschaft C, Bourgeois F, DuBois JM. Providing Adolescents with Access to Online Patient Portals: Interviews with Parent-Adolescent Dyads. J Pediatr 2024; 270:114015. [PMID: 38492914 DOI: 10.1016/j.jpeds.2024.114015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To identify perceived benefits, problems, facilitators, and barriers to adolescent online patient portal use. STUDY DESIGN Qualitative, semi-structured interviews with dyads of parents and adolescents with or without chronic illness. The study team purposively sampled for racial and ethnic minorities and fathers. Three team members then performed thematic analysis of the transcripts, with subsequent dyadic analysis of themes represented by related parents and adolescents. RESULTS We performed 102 interviews with 51 dyads of parents and adolescents (26 with chronic illness, 25 without chronic illness). Nearly all participants believed that adolescents should be permitted portal access. We identified 4 themes related to portal benefits: improves adolescent's knowledge of health; supports medical self-management and autonomy; strengthens communication and relationships; and supports parental influence. We identified 4 themes related to portal problems: misunderstanding or confusion; emotional distress; strain on relationships; and irresponsible use of portal. Facilitators of portal use included severity of illness, adolescent's curiosity, and ease of technology use. Barriers included lack of awareness or interest, complexity of information, and access difficulties. Twenty adolescents (39%) did not know they could access the portal, and 23 (45%) lacked interest in portals. Parents and adolescents seldom used the portal as a collaborative tool, and instead were engaging with the portal independently. CONCLUSION Parents and adolescents perceive several benefits and problems with portal use, but many adolescents lack interest in using portals. Adolescent portals represent an underutilized resource to engage adolescents in their care.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Bioethics Research Center, General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
| | - Alison L Antes
- Bioethics Research Center, General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Christine Bereitschaft
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Fabienne Bourgeois
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - James M DuBois
- Bioethics Research Center, General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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Schwarz J, Hoetger C, Pluschke LS, Muehlensiepen F, Schneider M, Thoma S, Esch T. Psychiatrists' perceptions of conditions and consequences associated with the implementation of open notes: qualitative investigation. BMC Psychiatry 2024; 24:430. [PMID: 38858711 PMCID: PMC11163720 DOI: 10.1186/s12888-024-05845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE In a growing list of countries, patients are granted access to their clinical notes ("open notes") as part of their online record access. Especially in the field of mental health, open notes remain controversial with some clinicians perceiving open notes as a tool for improving therapeutic outcomes by increasing patient involvement, while others fear that patients might experience psychological distress and perceived stigmatization, particularly when reading clinicians' notes. More research is needed to optimize the benefits and mitigate the risks. METHODS Using a qualitative research design, we conducted semi-structured interviews with psychiatrists practicing in Germany, to explore what conditions they believe need to be in place to ensure successful implementation of open notes in psychiatric practice as well as expected subsequent changes to their workload and treatment outcomes. Data were analyzed using thematic analysis. RESULTS We interviewed 18 psychiatrists; interviewees believed four key conditions needed to be in place prior to implementation of open notes including careful consideration of (1) diagnoses and symptom severity, (2) the availability of additional time for writing clinical notes and discussing them with patients, (3) available resources and system compatibility, and (4) legal and data protection aspects. As a result of introducing open notes, interviewees expected changes in documentation, treatment processes, and doctor-physician interaction. While open notes were expected to improve transparency and trust, participants anticipated negative unintended consequences including the risk of deteriorating therapeutic relationships due to note access-related misunderstandings and conflicts. CONCLUSION Psychiatrists practiced in Germany where open notes have not yet been established as part of the healthcare data infrastructure. Interviewees were supportive of open notes but had some reservations. They found open notes to be generally beneficial but anticipated effects to vary depending on patient characteristics. Clear guidelines for managing access, time constraints, usability, and privacy are crucial. Open notes were perceived to increase transparency and patient involvement but were also believed to raise issues of stigmatization and conflicts.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany.
| | - Cosima Hoetger
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lena-Sophie Pluschke
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Felix Muehlensiepen
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf, Germany
| | - Michael Schneider
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Samuel Thoma
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Tobias Esch
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
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Salmi L, Hubbard J, McFarland DC. When Bad News Comes Through the Portal: Strengthening Trust and Guiding Patients When They Receive Bad Results Before Their Clinicians. Am Soc Clin Oncol Educ Book 2024; 44:e433944. [PMID: 38848509 DOI: 10.1200/edbk_433944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Communication in oncology was challenging long before the emergence of the US 21st Century Cures Act. Before 2021, a growing body of evidence had demonstrated the benefits of patients' access to and review of the clinical notes in their charts (open notes); however, studies examining the benefits of immediate access to test results were scarce until the implementation of the Cures Act's Information Blocking Rule. Individuals grappling with cancer today now possess immediate access to their laboratory results, imaging scans, diagnostic tests, and progress notes as mandated by law. To many clinicians, the implementation of the Cures Act felt sudden and presented new challenges and concerns for oncologists surrounding patients' potential emotional reactions to medical notes or lack of control over the careful delivery of potentially life-changing information. Despite data that show most patients want immediate access to information in their records before it is communicated directly by a health care professional, surveys of oncologists showed trepidation. In this chapter, perspectives from a patient with cancer, an oncologist, and a cancer psychiatrist (in that order) are shared to illuminate the adjustments made in clinician-patient communication amid the era of nearly instantaneous results within the electronic health record.
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Affiliation(s)
- Liz Salmi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Daniel C McFarland
- Department of Psychiatry/Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
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10
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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Technical Report. Pediatrics 2024; 153:e2024066327. [PMID: 38646698 DOI: 10.1542/peds.2024-066327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is a foundational element of high-quality, accessible, and equitable health care. Despite strong grounding in federal and state laws, professional guidelines, and ethical standards, health care professionals and adolescent patients face a range of complexities and barriers to seeking and providing confidential care to adolescents across different settings and circumstances. The dynamic needs of adolescents, the oftentimes competing interests of key stakeholders, the rapidly evolving technological context of care, and variable health care billing and claims requirements are all important considerations in understanding how to optimize care to focus on and meet the needs of the adolescent patient. The following assessment of the evolving evidence base offers a view of the current state and best practices while pointing to numerous unmet needs and opportunities for improvement in the care experiences of youth as well as their health outcomes.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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Benjamins J, de Vet E, de Mortier CA, Haveman-Nies A. The Effect of Using a Client-Accessible Health Record on Perceived Quality of Care: Interview Study Among Parents and Adolescents. J Particip Med 2024; 16:e50092. [PMID: 38652532 PMCID: PMC11077414 DOI: 10.2196/50092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/11/2023] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patient-accessible electronic health records (PAEHRs) are assumed to enhance the quality of care, expressed in terms of safety, effectiveness, timeliness, person centeredness, efficiency, and equity. However, research on the impact of PAEHRs on the perceived quality of care among parents, children, and adolescents is largely lacking. In the Netherlands, a PAEHR (Iuvenelis) was developed for preventive child health care and youth care. Parents and adolescents had access to its full content, could manage appointments, ask questions, and comment on written reports. OBJECTIVE This study aims to assess whether and how using this PAEHR contributes to perceived quality of care from a client's perspective. METHODS We chose a qualitative design with a phenomenological approach to explore how parents and adolescents perceived the impact of using a PAEHR on quality of care. In-depth interviews that simultaneously included 1 to 3 people were conducted in 2021. In total, 20 participants were included in the study, representing parents and adolescents, both sexes, different educational levels, different native countries, and all participating municipalities. Within this group, 7 of 13 (54%) parents had not previously been informed about the existence of a client portal. Their expectations of using the client portal, in relation to quality of care, were discussed after a demonstration of the portal. RESULTS Parents and adolescents perceived that using Iuvenelis contributed to the quality of care because they felt better informed and more involved in the care process than before the introduction of Iuvenelis. Moreover, they experienced more control over their health data, faster and simpler access to their health information, and found it easier to manage appointments or ask questions at their convenience. Parents from a migratory background, among whom 6 of 7 (86%) had not previously been informed about the portal, expected that portal access would enhance their understanding of and control over their care processes. The parents expressed concerns about equity because parents from a migratory background might have less access to the service. Nevertheless, portal usability was regarded as high. Furthermore, both parents and adolescents saw room for improvement in the broader interdisciplinary use of Iuvenelis and the quality of reporting. CONCLUSIONS Using Iuvenelis can contribute to the client-experienced quality of care, more specifically to perceived person centeredness, timeliness, safety, efficiency, and integration of care. However, some quality aspects, such as equity, still need addressing. In general, client information about the portal needs to be improved, specifically focusing on people in vulnerable circumstances, such as those from migratory backgrounds. In addition, to maximize the potential benefit of using Iuvenelis, stimulating a person-centered attitude among professionals is important. Considering the small number of adolescent participants (n=7), adding quantitative data from a structured survey could strengthen the available evidence.
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Affiliation(s)
- Janine Benjamins
- Chairgroup Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- Icare JGZ, Meppel, Netherlands
- Stichting Jeugd Noord Veluwe, Nunspeet, Netherlands
| | - Emely de Vet
- Chairgroup Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- University Collega Tilburg, Tilburg University, Tilburg, Netherlands
| | - Chloe A de Mortier
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Knowledge Instiute of Medical Specialists, Utrecht, Netherlands
| | - Annemien Haveman-Nies
- Chairgroup Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- GGD Noord-en Oost Gelderland, Warnsveld, Netherlands
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Eng K, Johnston K, Cerda I, Kadakia K, Mosier-Mills A, Vanka A. A Patient-Centered Documentation Skills Curriculum for Preclerkship Medical Students in an Open Notes Era. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11392. [PMID: 38533390 PMCID: PMC10963659 DOI: 10.15766/mep_2374-8265.11392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/04/2024] [Indexed: 03/28/2024]
Abstract
Introduction New legislation allows patients (with permitted exceptions) to read their clinical notes, leading to both benefits and ethical dilemmas. Medical students need a robust curriculum to learn documentation skills within this challenging context. We aimed to teach note-writing skills through a patient-centered lens with special consideration for the impact on patients and providers. We developed this session for first-year medical students within their foundational clinical skills course to place bias-free language at the forefront of how they learn to construct a medical note. Methods One hundred seventy-three first-year medical and dental students participated in this curriculum. They completed an asynchronous presession module first, followed by a 2-hour synchronous workshop including a didactic, student-led discussion and sample patient note exercise. Students were subsequently responsible throughout the year for constructing patient-centered notes, graded by faculty with a newly developed rubric and checklist of best practices. Results On postworkshop surveys, learners reported increased preparedness in their ability to document in a patient-centered manner (presession M = 2.2, midyear M = 3.9, p < .001), as rated on a 5-point Likert scale (1 = not prepared at all, 5 = very prepared), and also found this topic valuable to learn early in their training. Discussion This curriculum utilizes a multipart approach to prepare learners to employ clinical notes to communicate with patients and providers, with special attention to how patients and their care partners receive a note. Future directions include expanding the curriculum to higher levels of learning and validating the developed materials.
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Affiliation(s)
- Kathleen Eng
- Fourth-Year Medical Student, Harvard Medical School
| | | | - Ivo Cerda
- Third-Year Medical Student, Harvard Medical School
| | | | | | - Anita Vanka
- Assistant Professor, Department of Medicine, Harvard Medical School
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Sisk B, Antes AL, Bereitschaft C, Enloe M, Bourgeois F, DuBois J. Guiding Principles for Adolescent Web-Based Portal Access Policies: Interviews With Informatics Administrators. JMIR Pediatr Parent 2024; 7:e49177. [PMID: 38466976 DOI: 10.2196/49177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/17/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Web-based patient portals are tools that could support adolescents in managing their health and developing autonomy. However, informatics administrators must navigate competing interests when developing portal access policies for adolescents and their parents. OBJECTIVE We aimed to assess the perspectives of informatics administrators on guiding principles for the development of web-based health care portal access policies in adolescent health care. METHODS We interviewed informatics administrators from US hospitals with ≥50 dedicated pediatric beds. We performed a thematic analysis of guiding principles for developing and implementing adolescent portal access policies. RESULTS We interviewed 65 informatics leaders who represented 63 pediatric hospitals, 58 health care systems, 29 states, and 14,379 pediatric hospital beds. Participants described 9 guiding principles related to three overarching themes: (1) balancing confidentiality and other care needs, (2) balancing simplicity and granularity, and (3) collaborating and advocating. Participants described the central importance of prioritizing the health and safety of the adolescent while also complying with state and federal laws. However, there were differing beliefs about how to prioritize health and safety and what role parents should play in supporting the adolescent's health care. Participants also identified areas where clinicians and institutions can advocate for adolescents, especially with electronic health record vendors and legislators. CONCLUSIONS Informatics administrators provided guiding principles for adolescent portal access policies that aimed to balance the competing needs of adolescent confidentiality and the usefulness of the portal. Portal access policies must prioritize the adolescent's health and safety while complying with state and federal laws. However, institutions must determine how to best enact these principles. Institutions and clinicians should strive for consensus on principles to strengthen advocacy efforts with institutional leadership, electronic health record vendors, and lawmakers.
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Affiliation(s)
- Bryan Sisk
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, MO, United States
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Alison L Antes
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, MO, United States
| | - Christine Bereitschaft
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Madi Enloe
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Fabienne Bourgeois
- Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - James DuBois
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, MO, United States
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Higa-McMillan CK, Park AL, Daleiden EL, Becker KD, Bernstein A, Chorpita BF. Getting More Out of Clinical Documentation: Can Clinical Dashboards Yield Clinically Useful Information? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:268-285. [PMID: 38261119 DOI: 10.1007/s10488-023-01329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
This study investigated coded data retrieved from clinical dashboards, which are decision-support tools that include a graphical display of clinical progress and clinical activities. Data were extracted from clinical dashboards representing 256 youth (M age = 11.9) from 128 practitioners who were trained in the Managing and Adapting Practice (MAP) system (Chorpita & Daleiden in BF Chorpita EL Daleiden 2014 Structuring the collaboration of science and service in pursuit of a shared vision. 43(2):323 338. 2014, Chorpita & Daleiden in BF Chorpita EL Daleiden 2018 Coordinated strategic action: Aspiring to wisdom in mental health service systems. 25(4):e12264. 2018) in 55 agencies across 5 regional mental health systems. Practitioners labeled up to 35 fields (i.e., descriptions of clinical activities), with the options of drawing from a controlled vocabulary or writing in a client-specific activity. Practitioners then noted when certain activities occurred during the episode of care. Fields from the extracted data were coded and reliability was assessed for Field Type, Practice Element Type, Target Area, and Audience (e.g., Caregiver Psychoeducation: Anxiety would be coded as Field Type = Practice Element; Practice Element Type = Psychoeducation; Target Area = Anxiety; Audience = Caregiver). Coders demonstrated moderate to almost perfect interrater reliability. On average, practitioners recorded two activities per session, and clients had 10 unique activities across all their sessions. Results from multilevel models showed that clinical activity characteristics and sessions accounted for the most variance in the occurrence, recurrence, and co-occurrence of clinical activities, with relatively less variance accounted for by practitioners, clients, and regional systems. Findings are consistent with patterns of practice reported in other studies and suggest that clinical dashboards may be a useful source of clinical information. More generally, the use of a controlled vocabulary for clinical activities appears to increase the retrievability and actionability of healthcare information and thus sets the stage for advancing the utility of clinical documentation.
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Dong Z, Leveille S, Lewis D, Walker J. People with diabetes who read their clinicians' visit notes: Behaviors and attitudes. Chronic Illn 2024; 20:173-183. [PMID: 37151042 DOI: 10.1177/17423953231171890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To understand behaviors and attitudes of adults with diabetes who read their clinicians' visit notes. METHODS By linking a large 2017 patient survey involving three institutions with administrative and portal use data, we identified patients with diabetes mellitus from outpatient records and examined reading behaviors related to eligible notes-initial, follow-up, history and physical, and progress notes. We analyzed patients' perceived benefits of reading notes. RESULTS 2104 respondents had diagnoses of diabetes mellitus and had read ≥1 note in the 12-month period. Patients had an average of 8.7 eligible notes available and read 59% of them. The strongest predictor of reading more notes was having more notes available; the specialties of the authoring clinicians were not correlated with note reading rates. Patients reported understanding notes by primary care clinicians and specialists equally well; more than 90% of patients reported understanding everything or almost everything in a self-selected note. Across visit types, 73-80% of patients reported that note reading was extremely important for taking care of their health. DISCUSSION People with diabetes want to read their clinicians' notes, are accessing them at high rates, and report understanding the notes and benefiting from reading them.
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Affiliation(s)
- Zhiyong Dong
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suzanne Leveille
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA
| | | | - Jan Walker
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Bell SK, Amat MJ, Anderson TS, Aronson MD, Benneyan JC, Fernandez L, Ricci DA, Salant T, Schiff GD, Shafiq U, Singer SJ, Sternberg SB, Zhang C, Phillips RS. Do patients who read visit notes on the patient portal have a higher rate of "loop closure" on diagnostic tests and referrals in primary care? A retrospective cohort study. J Am Med Inform Assoc 2024; 31:622-630. [PMID: 38164964 PMCID: PMC10873783 DOI: 10.1093/jamia/ocad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES The 2021 US Cures Act may engage patients to help reduce diagnostic errors/delays. We examined the relationship between patient portal registration with/without note reading and test/referral completion in primary care. MATERIALS AND METHODS Retrospective cohort study of patients with visits from January 1, 2018 to December 31, 2021, and order for (1) colonoscopy, (2) dermatology referral for concerning lesions, or (3) cardiac stress test at 2 academic primary care clinics. We examined differences in timely completion ("loop closure") of tests/referrals for (1) patients who used the portal and read ≥1 note (Portal + Notes); (2) those with a portal account but who did not read notes (Portal Account Only); and (3) those who did not register for the portal (No Portal). We estimated the predictive probability of loop closure in each group after adjusting for socio-demographic and clinical factors using multivariable logistic regression. RESULTS Among 12 849 tests/referrals, loop closure was more common among Portal+Note-readers compared to their counterparts for all tests/referrals (54.2% No Portal, 57.4% Portal Account Only, 61.6% Portal+Notes, P < .001). In adjusted analysis, compared to the No Portal group, the odds of loop closure were significantly higher for Portal Account Only (OR 1.2; 95% CI, 1.1-1.4), and Portal+Notes (OR 1.4; 95% CI, 1.3-1.6) groups. Beyond portal registration, note reading was independently associated with loop closure (P = .002). DISCUSSION AND CONCLUSION Compared to no portal registration, the odds of loop closure were 20% higher in tests/referrals for patients with a portal account, and 40% higher in tests/referrals for note readers, after controlling for sociodemographic and clinical factors. However, important safety gaps from unclosed loops remain, requiring additional engagement strategies.
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Affiliation(s)
- Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Maelys J Amat
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Timothy S Anderson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Mark D Aronson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, Boston, MA 02115, United States
| | - Leonor Fernandez
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Dru A Ricci
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
| | - Talya Salant
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
- Bowdoin Street Health Center, Dorchester, MA 02122, United States
| | - Gordon D Schiff
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Umber Shafiq
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Sara J Singer
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Scot B Sternberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Cancan Zhang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Russell S Phillips
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
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Schwarz J, Meier-Diedrich E, Neumann K, Heinze M, Eisenmann Y, Thoma S. Reasons for Acceptance or Rejection of Online Record Access Among Patients Affected by a Severe Mental Illness: Mixed Methods Study. JMIR Ment Health 2024; 11:e51126. [PMID: 38315523 PMCID: PMC10877495 DOI: 10.2196/51126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/10/2023] [Accepted: 11/29/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Over the past few years, online record access (ORA) has been established through secure patient portals in various countries, allowing patients to access their health data, including clinical notes ("open notes"). Previous research indicates that ORA in mental health, particularly among patients with severe mental illness (SMI), has been rarely offered. Little is known about the expectations and motivations of patients with SMI when reading what their clinicians share via ORA. OBJECTIVE The aim of this study is to explore the reasons why patients with SMI consider or reject ORA and whether sociodemographic characteristics may influence patient decisions. METHODS ORA was offered to randomly selected patients at 3 university outpatient clinics in Brandenburg, Germany, which exclusively treat patients with SMI. Within the framework of a mixed methods evaluation, qualitative interviews were conducted with patients who chose to participate in ORA and those who declined, aiming to explore the underlying reasons for their decisions. The interviews were transcribed and analyzed using thematic analysis. Sociodemographic characteristics of patients were examined using descriptive statistics to identify predictors of acceptance or rejection of ORA. RESULTS Out of 103 included patients, 58% (n=60) wished to read their clinical notes. The reasons varied, ranging from a desire to engage more actively in their treatment to critically monitoring it and using the accessible data for third-party purposes. Conversely, 42% (n=43) chose not to use ORA, voicing concerns about possibly harming the trustful relationship with their clinicians as well as potential personal distress or uncertainty arising from reading the notes. Practical barriers such as a lack of digital literacy or suspected difficult-to-understand medical language were also named as contributing factors. Correlation analysis revealed that the majority of patients with depressive disorder desired to read the clinical notes (P<.001), while individuals with psychotic disorders showed a higher tendency to decline ORA (P<.05). No significant group differences were observed for other patient groups or characteristics. CONCLUSIONS The adoption of ORA is influenced by a wide range of motivational factors, while patients also present a similar variety of reasons for declining its use. The results emphasize the urgent need for knowledge and patient education regarding factors that may hinder the decision to use ORA, including its practical usage, its application possibilities, and concerns related to data privacy. Further research is needed to explore approaches for adequately preparing individuals with SMI to transition from their inherent interest to active engagement with ORA. TRIAL REGISTRATION German Clinical Trial Register DRKS00030188; https://drks.de/search/en/trial/DRKS00030188.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Center for Health Service Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Eva Meier-Diedrich
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Katharina Neumann
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Center for Health Service Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Yvonne Eisenmann
- Center for Health Service Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Samuel Thoma
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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Nacht CL, Jacobson N, Shiyanbola O, Smith CA, Hoonakker PL, Coller RJ, Dean SM, Sklansky DJ, Smith W, Sprackling CM, Kelly MM. Perception of Physicians' Notes Among Parents of Different Health Literacy Levels. Hosp Pediatr 2024; 14:108-115. [PMID: 38173406 PMCID: PMC10823185 DOI: 10.1542/hpeds.2023-007240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To explore the benefits and challenges of accessing physicians' notes during pediatric hospitalization across parents of different health literacy levels. METHODS For this secondary analysis, we used semi-structured interviews conducted with 28 parents on their impressions of having access to their child's care team notes on a bedside table. Three researchers used thematic analysis to develop a codebook, coded interview data, and identified themes. Parent interviews and respective themes were then dichotomized into proficient or limited health literacy groups and compared. RESULTS Nine themes were identified in this secondary analysis: 6 benefits and 3 challenges. All parents identified more benefits than challenges, including that the notes served as a recap of information and memory aid and increased autonomy, empowerment, and advocacy for their child. Both groups disliked receiving bad news in notes before face-to-face communication. Parents with proficient literacy reported that notes allowed them to check information accuracy, but that notes may not be as beneficial for parents with lower health literacy. Parents with limited literacy uniquely identified limited comprehension of medical terms but indicated that notes facilitated their understanding of their child's condition, increased their appreciation for their health care team, and decreased their anxiety, stress, and worry. CONCLUSIONS Parents with limited health literacy uniquely reported that notes improved their understanding of their child's care and decreased (rather than increased) worry. Reducing medical terminology may be one equitable way to increase note accessibility for parents across the health literacy spectrum.
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Affiliation(s)
- Carrie L. Nacht
- School of Public Health, San Diego State University, San Diego, California
| | - Nora Jacobson
- Institute for Clinical and Translational Research and School of Nursing
| | | | | | - Peter L.T. Hoonakker
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ryan J. Coller
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | | | - Daniel J. Sklansky
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | | | - Carley M. Sprackling
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | - Michelle M. Kelly
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
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Kostick-Quenet KM, Herrington J, Storch EA. Personalized Roadmaps for Returning Results From Digital Phenotyping. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:102-105. [PMID: 38295237 PMCID: PMC10942668 DOI: 10.1080/15265161.2023.2296454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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20
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Blease CR, Kharko A, Dong Z, Jones RB, Davidge G, Hagglund M, Turner A, DesRoches C, McMillan B. Experiences and opinions of general practitioners with patient online record access: an online survey in England. BMJ Open 2024; 14:e078158. [PMID: 38302414 PMCID: PMC10806584 DOI: 10.1136/bmjopen-2023-078158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE To describe the experiences and opinions of general practitioners (GPs) in England regarding patients having access to their full online GP health records. DESIGN Convenience sample, online survey. PARTICIPANTS 400 registered GPs in England. MAIN OUTCOME MEASURES Investigators measured GPs' experiences and opinions about online record access (ORA), including patient care and their practice. RESULTS A total of 400 GPs from all regions of England responded. A minority (130, 33%) believed ORA was a good idea. Most GPs believed a majority of patients would worry more (364, 91%) or find their GP records more confusing than helpful (338, 85%). Most GPs believed a majority of patients would find significant errors in their records (240, 60%), would better remember their care plan (280, 70%) and feel more in control of their care (243, 60%). The majority believed they will/already spend more time addressing patients' questions outside of consultations (357, 89%), that consultations will/already take significantly longer (322, 81%) and that they will be/already are less candid in their documentation (289, 72%) after ORA. Nearly two-thirds of GPs believed ORA would increase their litigation (246, 62%). CONCLUSIONS Similar to clinicians in other countries, GPs in our sample were sceptical of ORA, believing patients would worry more and find their records more confusing than helpful. Most GPs also believed the practice would exacerbate work burdens. However, the majority of GPs in this survey also agreed there were multiple benefits to patients having online access to their primary care health records. The findings of this survey also contribute to a growing body of contrastive research from countries where ORA is advanced, demonstrating clinicians are sceptical while studies indicate patients appear to derive multiple benefits.
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Affiliation(s)
- Charlotte R Blease
- Uppsala Universitet, Uppsala, Sweden
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Kharko
- Faculty of Health, University of Plymouth, Plymouth, UK
- Department of Women and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Zhiyong Dong
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ray B Jones
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Maria Hagglund
- Department of Women and Children's Health, Uppsala Universitet, Uppsala, Sweden
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | | | - Catherine DesRoches
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
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Huang SS, Stenner SP, Rosenbloom ST. The 21st Century Cures Act Information Blocking Rule in Post-Acute Long-Term Care. J Am Med Dir Assoc 2024; 25:58-60. [PMID: 37402466 DOI: 10.1016/j.jamda.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023]
Abstract
Included as part of the 21st Century Cures Act, the information blocking rule entered the first compliance phase in April 2021. Under this rule, post-acute long-term care (PALTC) facilities must not engage in any activity that interferes with accessing, using, or exchanging electronic health information. In addition, facilities must respond to information requests in a timely fashion and allow records to be readily available to patients and their delegates. Although hospitals have been slow to adapt to these changes, skilled nursing and other PALTC centers have been even slower. With a Final Rule enacted in recent years, awareness of the information-blocking rules became more crucial. We believe this commentary will help our colleagues interpret the rule for the PALTC setting. In addition, we provide points of emphasis to help guide those providers and administrative staff workers toward compliance and avoid potential penalties.
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Affiliation(s)
- Sean S Huang
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Shane P Stenner
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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22
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Sprackling CM, Kieren MQ, Nacht CL, Moreno MA, Wooldridge A, Kelly MM. Adolescent Access to Clinicians' Notes: Adolescent, Parent, and Clinician Perspectives. J Adolesc Health 2024; 74:155-160. [PMID: 37831050 PMCID: PMC10842681 DOI: 10.1016/j.jadohealth.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE In 2021, federal guidelines mandated that health-care organizations share clinicians' notes with patients to increase information transparency. While findings indicate advantages for adult patients, less is known about note-sharing from the viewpoint of adolescents. This study aims to identify adolescent, parent, and clinician perspectives on the anticipated benefits and concerns of giving adolescents access to clinicians' notes and strategies to support note-sharing in this population. METHODS We conducted six focus groups with adolescents, parents, and clinicians at a children's hospital from May to October 2021. A semistructured facilitator guide captured participant perspectives of note-sharing benefits, concerns, and strategies. Two researchers independently coded and analyzed transcript data using thematic analysis; a third researcher reconciled discrepancies. RESULTS 38 stakeholders (17 adolescents, 10 parents, and 11 clinicians) described four benefits, three concerns, and four implementation strategies regarding adolescent note-sharing. Potential benefits included adolescents using notes to remember and reinforce the visit, gaining knowledge about their health, strengthening the adolescent-clinician relationship, and increasing agency in health care decisions. Concerns included notes leading to a breach in confidentiality, causing negative emotions, and becoming less useful for clinicians. Strategies included making note-sharing more secure, optimizing note layout and content, setting clear expectations, and having a portion of the note for clinician use only. DISCUSSION Stakeholders suggest multiple strategies to optimize the implementation of note-sharing to support adolescent patients, parents, and clinicians as hospitals work to comply with federal regulations. These strategies may reinforce the potential benefits and mitigate the challenges of sharing notes with adolescent patients.
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Affiliation(s)
- Carley M Sprackling
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Madeline Q Kieren
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, California
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Abigail Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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23
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Schwarz J, Neumann K, Meier-Diedrich E, Mühlensiepen F, Hochwarter S, Blease C. Psychotherapists' views on open notes: An online survey from Germany. Digit Health 2024; 10:20552076241271813. [PMID: 39291155 PMCID: PMC11406606 DOI: 10.1177/20552076241271813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/04/2024] [Indexed: 09/19/2024] Open
Abstract
Background In an increasing number of countries, patients are given online record access (ORA) to their clinical notes ("open notes"). In many places, psychotherapy notes are exempt, even if patients explicitly wish to read them. Previous research suggests that psychotherapists (PTs) have reservations that are not yet fully understood. Objective To investigate the attitudes and perceived effects of open notes on psychotherapeutic care, patients, and individual psychotherapeutic practice in Germany. Methods Psychological and medical therapists were invited to participate in a national online survey. Sociodemographic characteristics such as gender, age, professional group, and psychotherapeutic school were gathered. Descriptive statistics were used to analyze the 51-item survey. Results 129 PTs completed the survey. Only a small proportion of respondents (30 out of 129, 23.3%) suspected that open notes would improve the efficiency of psychotherapeutic care. On the one hand, participants assumed that patients gain more control over their treatment (59 out of 129, 45.7%) and are better able to remember therapy goals (55 out of 129, 42.6%), although this was considered unlikely to lead to greater engagement in the therapy process (94 out of 129, 72.9%). On the other hand, PTs expected patients to misunderstand their notes, feel offended (98 out of 129, 76.0%), and approach them with questions (107 out of 129, 82.9%) or requests for changes (94 out of 129, 72.9%). The respondents also anticipated being less honest when writing (95 out of 129, 73.6%) and reported they needed more time for documentation (99 out of 129, 76.7%). A meaningful use of open notes for working with relatives was envisaged (101 out of 129, 78.3%). Conclusion PTs in Germany tend to have a negative attitude towards patients' ORA on open notes. Further research on clinical efficacy and feasibility is necessary to demonstrate whether open notes add value in the context of psychotherapy.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Katharina Neumann
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Department for Addictive Disorders, Salus Hospital Lindow, Lindow, Germany
| | - Eva Meier-Diedrich
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Felix Mühlensiepen
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Stefan Hochwarter
- HEALTH - Institute for Biomedical Research and Technologies, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Charlotte Blease
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Division of General Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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24
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Virtanen L, Kaihlanen AM, Saukkonen P, Reponen J, Lääveri T, Vehko T, Saastamoinen P, Viitanen J, Heponiemi T. Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample. BMC Med Inform Decis Mak 2023; 23:252. [PMID: 37940995 PMCID: PMC10631156 DOI: 10.1186/s12911-023-02351-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Physicians' work is often stressful. The digitalization of healthcare aims to streamline work, but not all physicians have experienced its realization. We examined associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians. The moderating role of the length of work experience was investigated for these associations. METHODS We used representative survey data on Finnish physicians' (N = 4271) experiences of digitalization from 2021. The independent variables included perceptions on statements about work transformations aligned with digitalization goals, and the extent that information systems and teleconsultations were utilized. Stress related to information systems (SRIS), time pressure, and psychological stress were the dependent variables. We analyzed the associations using multivariable linear and logistic regressions. RESULTS Respondents had a mean SRIS score of 3.5 and a mean time pressure score of 3.7 on a scale of 1-5. Psychological stress was experienced by 60%. Perceptions associated with higher SRIS comprised disagreements with statements asserting that digitalization accelerates clinical encounters (b = .23 [95% CI: .16-.30]), facilitates access to patient information (b = .15 [.07-.23]), and supports decision-making (b = .11 [.05-.18]). Disagreement with accelerated clinical encounters (b = .12 [.04-.20]), and agreements with patients' more active role in care (b = .11 [.04-.19]) and interprofessional collaboration (b = .10 [.02-.18]) were opinions associated with greater time pressure. Disagreeing with supported decision-making (OR = 1.26 [1.06-1.48]) and agreeing with patients' active role (OR = 1.19 [1.02-1.40]) were associated with greater psychological stress. However, perceiving improvements in the pace of clinical encounters and access to patient information appeared to alleviate job strain. Additionally, extensive digital work was consistently linked to higher strain. Those respondents who held teleconsultations frequently and had less than 6 years of work experience reported the greatest levels of time pressure. CONCLUSIONS Physicians seem to be strained by frequent teleconsultations and work that does not meet the goals of digitalization. Improving physicians' satisfaction with digitalization through training specific to the stage of career and system development can be crucial for their well-being. Schedules for digital tasks should be planned and allocated to prevent strain related to achieving the digitalization goals.
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Affiliation(s)
- Lotta Virtanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland.
| | - Anu-Marja Kaihlanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland
| | - Petra Saukkonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland
| | - Jarmo Reponen
- Research Unit of Health Sciences and Technology, University of Oulu, P.O.Box 5000, 90014, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, P.O.Box 8000, 90014, Oulu, Finland
| | - Tinja Lääveri
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, P.O.Box 700, 00029, Helsinki, Finland
- Department of Computer Science, Aalto University, P.O.Box 15400, 00076, Espoo, Finland
| | - Tuulikki Vehko
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland
| | | | - Johanna Viitanen
- Department of Computer Science, Aalto University, P.O.Box 15400, 00076, Espoo, Finland
| | - Tarja Heponiemi
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland
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Lamar CE, Jain D, Schmitz KH. Perils of Auto-Population of Newborn EHR With Maternal Intimate Partner Violence History. Pediatrics 2023; 152:e2022060189. [PMID: 37712123 DOI: 10.1542/peds.2022-060189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 09/16/2023] Open
Abstract
In 2020, the 21st Century Cures Act was enacted, mandating that patients have access to their electronic health record. This has the potential to benefit both patients and clinicians by increasing communication, transparency, and patient autonomy. However, with the onset of the act, a number of unintended consequences of the act have been identified. Presently, we discuss a case where documentation of intimate partner violence and the safety plan documented in a mother's electronic health record automatically populated her newborn's admission note. This confidential information inadvertently became accessible to the perpetrator: the infant's father.
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Affiliation(s)
- Casey E Lamar
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Deepak Jain
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kristine H Schmitz
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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26
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Sisk BA, Lin S, Balls-Berry J(JE, Servin AE, Mack JW. Identifying contributors to disparities in patient access of online medical records: examining the role of clinician encouragement. JAMIA Open 2023; 6:ooad049. [PMID: 37425488 PMCID: PMC10325895 DOI: 10.1093/jamiaopen/ooad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/30/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023] Open
Abstract
Objective The aim of this study was to understand the influence of clinician encouragement and sociodemographic factors on whether patients access online electronic medical records (EMR). Materials and Methods We analyzed 3279 responses from the Health Information National Trends Survey 5 cycle 4 survey, a cross-sectional, nationally representative survey administered by the National Cancer Institute. Frequencies and weighted proportions were calculated to compare clinical encouragement and access to their online EMR. Using multivariate logistic regression, we identified factors associated with online EMR use and clinician encouragement. Results In 2020, an estimated 42% of US adults accessed their online EMR and 51% were encouraged by clinicians to access their online EMR. In multivariate regression, respondents who accessed EMR were more likely to have received clinician encouragement (odds ratio [OR], 10.3; 95% confidence interval [CI], 7.7-14.0), college education or higher (OR, 1.9; 95% CI, 1.4-2.7), history of cancer (OR, 1.5; 95% CI, 1.0-2.3), and history of chronic disease (OR, 2.3; 95% CI, 1.7-3.2). Male and Hispanic respondents were less likely to have accessed EMR than female and non-Hispanic White respondents (OR, 0.6; 95% CI, 0.5-0.8, and OR, 0.5; 95% CI, 0.3-0.8, respectively). Respondents receiving encouragement from clinicians were more likely to be female (OR, 1.7; 95% CI, 1.3-2.3), have college education (OR, 1.5; 95% CI, 1.1-2.0), history of cancer (OR, 1.8; 95% CI, 1.3-2.5), and greater income levels (OR, 1.8-3.6). Discussion Clinician encouragement of patient EMR use is strongly associated with patients accessing EMR, and there are disparities in who receives clinician encouragement related to education, income, sex, and ethnicity. Conclusions Clinicians have an important role to ensure that all patients benefit from online EMR use.
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Affiliation(s)
- Bryan A Sisk
- Corresponding Author: Bryan A. Sisk, MD, Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, 4523 Clayton Avenue, 8005, St. Louis, MO 63110, USA;
| | - Sunny Lin
- General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Argentina E Servin
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts, USA
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27
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Alpert JM, Sharma B, Cenko E, Zapata R, Karnati Y, Fillingim RB, Gill TM, Marsiske M, Ranka S, Manini T. Identifying barriers and facilitators for using a smartwatch to monitor health among older adults. EDUCATIONAL GERONTOLOGY 2023; 50:282-295. [PMID: 38737621 PMCID: PMC11081104 DOI: 10.1080/03601277.2023.2260970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Smartwatches are a type of wearable device that enable continuous monitoring of an individual's activities and critical health metrics. As the number of older adults age 65+ continues to grow in the U.S., so does their usage of smartwatches, making it necessary to understand the real-world uptake and use of these devices to monitor health. In this study, older adults with a relatively high level of education and digital skills were provided with a smartwatch equipped with a mobile application (ROAMM) that was worn for a median of 14 days. Usability surveys were distributed, and a qualitative analysis was performed about participants' experience using the smartwatch and ROAMM application. Constructs from the Technology Acceptance Model and Consolidated Framework for Implementation Research were incorporated into in-depth interviews, which were recorded and transcribed. Data were analyzed using the constant comparative method. Interviews among 30 older adults revealed the following main themes: 1) familiarization with the device and adoption and acceptance, 2) factors encouraging usage, such as a doctor's endorsement or the appeal of tracking one's health, and 3) barriers to usage, such as insufficient education and training and the desire for additional functionality. Overall, participants found the smartwatch easy to use and were likely to continue using the device in a long-term study. Data generated from smartwatches have the potential to engage individuals about their health and could inspire them to participate more actively during clinical encounters.
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Affiliation(s)
- Jordan M. Alpert
- Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, OH, USA
| | - Bhakti Sharma
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Erta Cenko
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Ruben Zapata
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Yashaswi Karnati
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Thomas M. Gill
- Department of Medicine, Yale University, New Haven, CT, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology in the College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Sanjay Ranka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Todd Manini
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
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28
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Sisk BA, Bereitschaft C, Enloe M, Schulz G, Mack J, DuBois J. Oncology Clinicians' Perspectives on Online Patient Portal Use in Pediatric and Adolescent Cancer. JCO Clin Cancer Inform 2023; 7:e2300124. [PMID: 37972324 DOI: 10.1200/cci.23.00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Online patient portals represent widely available communication tools in pediatric oncology. Previous studies have not evaluated clinicians' perspectives on portal use, including issues related to access to adolescents' portals. METHODS We performed semistructured interviews with physicians and advanced practice providers (APPs) who care for children or adolescents with cancer. We performed thematic analysis of benefits, problems, and accommodations related to portal use in oncology. RESULTS We interviewed 29 physicians and 24 APPs representing 26 institutions. Participants described five themes of benefits provided by portals: (1) empowering adolescents, (2) improving efficiency and accuracy of communication, (3) promoting open and adaptive communication, (4) supporting parents in managing care, and (5) bolstering clinical relationships. Participants described eight themes of problems caused by portal access: (1) creating emotional distress and confusion, (2) increasing workload and changing workflows, (3) threatening adolescent confidentiality, (4) adolescents lacking interest to engage, (5) diminishing clinical relationship, (6) misusing portal messages, (7) diminishing quality of sensitive documentation, and (8) parents losing access to adolescents' records. Participants described three themes related to accommodations they made as a result of portal access: (1) modifying note writing, (2) providing anticipatory guidance about viewing results, and (3) adapting workflows. Some portal functions created either benefits or problems depending on the clinical context. CONCLUSION Oncologists identified benefits and problems created by portal use, which were sometimes in tension, depending on the clinical context. To make portals useful, we must take steps to mitigate risks while preserving functionality for parents and adolescent patients.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | | | - Madi Enloe
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Ginny Schulz
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Jennifer Mack
- Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - James DuBois
- Department of Medicine, Washington University School of Medicine, St Louis, MO
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29
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Dambrino RJ, Domenico HJ, Graves JA, Buntin MJB, Martinez W, Rosenbloom ST, Cooper WO. Unsolicited Patient Complaints Following the 21st Century Cures Act Information-Blocking Rule. JAMA HEALTH FORUM 2023; 4:e233244. [PMID: 37773508 PMCID: PMC10543134 DOI: 10.1001/jamahealthforum.2023.3244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/31/2023] [Indexed: 10/01/2023] Open
Abstract
Importance The 21st Century Cures Act includes an information-blocking rule (IBR) that requires health systems to provide patients with immediate access to their health information in the electronic medical record upon request. Patients accessing their health information before they receive an explanation from their health care team may experience confusion and may be more likely to share unsolicited patient complaints (UPCs) with their health care organization. Objective To evaluate the quantity of UPCs about physicians before and after IBR implementation and to identify themes in UPCs that may identify patient confusion, fear, or anger related to the release of information. Design, Setting, and Participants This retrospective cohort study was conducted with an interrupted time-series analysis of UPCs spanning January 1, 2020, to June 30, 2022. The data were obtained from a single academic medical center, Vanderbilt University Medical Center, at which the IBR was implemented on January 20, 2021. Data analysis was performed from January 11 to July 15, 2023. Exposure Implementation of the IBR on January 20, 2021. Main Outcomes and Measures The primary outcome was the monthly rate of UPCs before and after IBR implementation. A qualitative analysis was performed for UPCs received after IBR implementation. The Wilcoxon rank-sum test was used to compare monthly complaints between the pre- and post-IBR groups. The Pearson χ2 test was used to compare proportions of complaints by UPC category between time periods. Results The medical center received 8495 UPCs during the study period: 3022 over 12 months before and 5473 over 18 months after institutional IBR implementation. There was no difference in the monthly proportions of UPCs per 1000 patient encounters before (median, 0.81 [IQR, 0.75-0.88]) and after (median, 0.83 [IQR, 0.77-0.89]) IBR implementation (difference in medians, -0.02 [95% CI, -0.12 to 0.07]; P =.86). Segmented regression analysis revealed no difference in monthly UPCs (β [SE], 0.03 [0.09]; P =.72). Conclusions and Relevance In this cohort study, implementation of the Cures Act IBR was not associated with an increase in monthly rates of UPCs. These findings suggest that review of UPCs identified as IBR-specific complaints may allow clinicians and organizations to prepare patients that their test and procedure results may be available before clinicians are able to review them and respond.
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Affiliation(s)
- Robert J. Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Henry J. Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John A. Graves
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda J. B. Buntin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Carey Business School, Johns Hopkins University, Baltimore, Maryland
| | - William Martinez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. Trent Rosenbloom
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William O. Cooper
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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30
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Sisk BA, Antes AL, Bereitschaft C, Enloe M, Lin S, Srinivas M, Bourgeois F, DuBois JM. Engaging Adolescents in Using Online Patient Portals. JAMA Netw Open 2023; 6:e2330483. [PMID: 37610751 PMCID: PMC10448298 DOI: 10.1001/jamanetworkopen.2023.30483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/14/2023] [Indexed: 08/24/2023] Open
Abstract
Importance Many health care systems offer adolescents access to health information through online patient portals, but few studies have explored how to engage adolescents in using and benefiting from online portals. Objective To determine how US children's hospitals have attempted to encourage adolescent portal use, barriers to engaging adolescents, and ideal future goals for engagement. Design, Setting, and Participants This qualitative study performed structured qualitative interviews with informatics administrators from children's hospitals across the US between February and July 2022. Informatics administrators were employed by US health care systems that managed a children's hospital with at least 50 dedicated pediatrics beds. Data analysis was performed from November 2022 to January 2023. Main Outcomes and Measures This study used thematic analysis of (1) current steps that health care systems had taken to engage adolescents in using their online patient portals and (2) barriers to engaging adolescents and ideal future goals and outcomes of engagement. Results Among 58 total interviews with 65 informatics administrators who represented 63 hospitals across 58 health care systems, 6 themes of approaches to engaging adolescents in portal use were identified: (1) promoting and educating adolescents about portal enrollment, (2) establishing workflows to support enrollment, (3) seeking and incorporating feedback, (4) creating a culture or environment supporting engagement, (5) increasing portal utility, and (6) limited efforts. Barriers to engaging adolescents in portal use related to either (1) stakeholder investment, interest, and capabilities or (2) intersecting technical, ethical, and legal factors. Participants identified 4 ideal future efforts to engage adolescents: (1) develop adaptable private means of communication with adolescents, (2) use adolescent-centric user design, (3) enhance promotion and education about portal use, and (4) simplify and adapt workflows to encourage enrollment. Participants described 3 ideal outcomes of this future engagement: (1) provide education about current health, (2) prepare for transition to adulthood, and (3) improve digital health education of adolescents. Conclusions and Relevance In this qualitative study of informatics administrators, children's hospitals across the US were found to have varying degrees of efforts to engage adolescents in using their portals. Most of these efforts focused on supporting adolescent enrollment, but fewer efforts focused on making the portal useful and interesting to adolescents.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Alison L Antes
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Christine Bereitschaft
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Madi Enloe
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Sunny Lin
- General Medical Sciences, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Meghana Srinivas
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Fabienne Bourgeois
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - James M DuBois
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
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Thielmann RRLC, Hoving C, Cals JWL, Crutzen R. The Effects of Online Access to General Practice Medical Records Perceived by Patients: Longitudinal Survey Study. J Med Internet Res 2023; 25:e47659. [PMID: 37266981 DOI: 10.2196/47659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Patient online access to medical records is assumed to facilitate patient empowerment and advance patient-centered health care. However, to date, the actual effects of online access to medical records perceived by patients and other outcomes are insufficiently empirically tested. OBJECTIVE This study aimed to investigate the effects of online access to medical records on patient empowerment, informed decision-making, and the patient-provider relationship perceived by patients. METHODS A nationwide, 2-wave, longitudinal survey study was conducted among Dutch adults (N=2402). Linear regression analyses were performed. In model 1, the perceived effects of online access to medical records (measured at T1 [first measurement; July 2021]) on 16 outcomes (measured at T2 [second measurement; January 2022]), which were associated with the use of online access to general practice medical records in previous research, were investigated. Model 2 included sociodemographic factors and patient characteristics as confounders. RESULTS Users indicated more strongly than nonusers that online access to medical records would increase their participation in health care, improve the relationship with their general practitioner, and support informed decision-making. These results were robust when adjusted for the influence of confounders. Effect sizes were very small, with unstandardized regression coefficients (B) ranging between -0.39 and 0.28. Higher digital and health literacy were associated with higher ratings of almost all effects. CONCLUSIONS Online access to medical records has the potential to empower patients and foster informed decision-making among patients. The effects in this study were small but might grow over time. Other factors, such as the attitude of general practitioners toward online access to medical records, might moderate these effects. The results indicate that the potential benefits of online access to medical records might be unevenly distributed. We suggest future exploration of the conditions under which online access to medical records can improve health care system functioning and efficiency without increasing health inequality.
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Affiliation(s)
- Rosa R L C Thielmann
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Ciska Hoving
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jochen W L Cals
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Rik Crutzen
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Childers C, Marron J, Meyer EC, Abel GA. Clinical ethics consultation documentation in the era of open notes. BMC Med Ethics 2023; 24:27. [PMID: 37138339 PMCID: PMC10158359 DOI: 10.1186/s12910-023-00904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND In 2021, federal rules from the 21st Century Cures Act mandated most clinical notes be made available in real-time, online, and free of charge to patients, a practice often referred to as "open notes." This legislation was passed to support medical information transparency and reinforce trust in the clinician-patient relationship; however, it created additional complexities in that relationship and raises questions of what should be included in notes intended to be read by both clinicians and patients. MAIN BODY Even prior to open notes, how an ethics consultant should document a clinical ethics consultation was widely debated as there can be competing interests, differing moral values, and disagreement about pertinent medical information in any given encounter. Patients can now access documentation of these discussions through online portals which broach sensitive topics related to end-of-life care, autonomy, religious/cultural conflict, veracity, confidentiality, and many others. Clinical ethics consultation notes must be ethically robust, accurate, and helpful for healthcare workers and ethics committee members, but now also sensitive to the needs of patients and family members who can read them in real-time. CONCLUSION We explore implications of open notes for ethics consultation, review clinical ethics consultation documentation styles, and offer recommendations for documentation in this new era.
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Affiliation(s)
- Chad Childers
- Marian University College of Osteopathic Medicine, 3200 Cold Spring Rd, 46222, Indianapolis, IN, USA
- Center for Bioethics, Harvard Medical School, 641 Huntington Ave, 02115, Boston, MA, USA
| | - Jonathan Marron
- Center for Bioethics, Harvard Medical School, 641 Huntington Ave, 02115, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Ave, 02215, Boston, MA, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, 02215, Boston, MA, USA
| | - Elaine C Meyer
- Center for Bioethics, Harvard Medical School, 641 Huntington Ave, 02115, Boston, MA, USA
| | - Gregory A Abel
- Center for Bioethics, Harvard Medical School, 641 Huntington Ave, 02115, Boston, MA, USA.
- Division of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Ave, 02215, Boston, MA, USA.
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Rotholz S, Lin CT. "I don't think it should take you three days to tell me my baby is dead." A case of fetal demise: unintended consequences of immediate release of information. J Am Med Inform Assoc 2023:7148302. [PMID: 37130346 DOI: 10.1093/jamia/ocad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/04/2023] Open
Abstract
The 21st Century Cures Act (Cures Act) information blocking regulations mandate timely patient access to their electronic health information. In most healthcare systems, this technically requires immediate electronic release of test results and clinical notes directly to patients. Patients could potentially be distressed by receiving upsetting results through an electronic portal rather than from a clinician. We present a case from 2018, several years prior to the implementation of the Cures Act. A patient was notified of fetal demise detected by ultrasound through her electronic health record (EHR) patient portal before her clinician received the result. We discuss the patient's ensuing complaint and healthcare system response. This unusual and dramatic case of fetal demise is relevant today because it underscores the importance of involving a patient and family advisory council in decision-making. It also highlights the value of "anticipatory guidance" as a routine clinical practice in this era of immediate access to test results.
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Affiliation(s)
- Stephen Rotholz
- Department of Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Chen-Tan Lin
- Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Rabbani N, Bedgood M, Brown C, Steinberg E, Goldstein RL, Carlson JL, Pageler N, Morse KE. A Natural Language Processing Model to Identify Confidential Content in Adolescent Clinical Notes. Appl Clin Inform 2023; 14:400-407. [PMID: 36898410 PMCID: PMC10208722 DOI: 10.1055/a-2051-9764] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The 21st Century Cures Act mandates the immediate, electronic release of health information to patients. However, in the case of adolescents, special consideration is required to ensure that confidentiality is maintained. The detection of confidential content in clinical notes may support operational efforts to preserve adolescent confidentiality while implementing information sharing. OBJECTIVES This study aimed to determine if a natural language processing (NLP) algorithm can identify confidential content in adolescent clinical progress notes. METHODS A total of 1,200 outpatient adolescent progress notes written between 2016 and 2019 were manually annotated to identify confidential content. Labeled sentences from this corpus were featurized and used to train a two-part logistic regression model, which provides both sentence-level and note-level probability estimates that a given text contains confidential content. This model was prospectively validated on a set of 240 progress notes written in May 2022. It was subsequently deployed in a pilot intervention to augment an ongoing operational effort to identify confidential content in progress notes. Note-level probability estimates were used to triage notes for review and sentence-level probability estimates were used to highlight high-risk portions of those notes to aid the manual reviewer. RESULTS The prevalence of notes containing confidential content was 21% (255/1,200) and 22% (53/240) in the train/test and validation cohorts, respectively. The ensemble logistic regression model achieved an area under the receiver operating characteristic of 90 and 88% in the test and validation cohorts, respectively. Its use in a pilot intervention identified outlier documentation practices and demonstrated efficiency gains over completely manual note review. CONCLUSION An NLP algorithm can identify confidential content in progress notes with high accuracy. Its human-in-the-loop deployment in clinical operations augmented an ongoing operational effort to identify confidential content in adolescent progress notes. These findings suggest NLP may be used to support efforts to preserve adolescent confidentiality in the wake of the information blocking mandate.
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Affiliation(s)
- Naveed Rabbani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Michael Bedgood
- California Department of Public Health, Richmond, California, United States
| | - Conner Brown
- Information Services Department, Lucile Packard Children's Hospital, Palo Alto, California, United States
| | - Ethan Steinberg
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, California, United States
- Department of Computer Science, Stanford University, Stanford, California, United States
| | - Rachel L. Goldstein
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Jennifer L. Carlson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Natalie Pageler
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Keith E. Morse
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
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Anyidoho PA, Verschraegen CF, Markham MJ, Alberts S, Sweetenham J, Cameron K, Abu Hejleh T. Impact of the Immediate Release of Clinical Information Rules on Health Care Delivery to Patients With Cancer. JCO Oncol Pract 2023; 19:e706-e713. [PMID: 36780583 PMCID: PMC10414766 DOI: 10.1200/op.22.00712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/20/2022] [Accepted: 01/06/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE The 21st Century Cures Act mandates the immediate release of clinical information (IRCI) to patients. Immediate sharing of sensitive test results to patients with cancer might have serious unintended consequences for patients and providers. METHODS A 22-question REDCap survey was designed by the Association of American Cancer Institutes Physician Clinical Leadership Initiative Steering Committee to explore oncology providers' opinions on IRCI policy implementation. It was administered twice in 2021 with a 3-month interval. A third survey with a single question seeking providers' opinions about their adaptation to the IRCI mandate was administered 1 year later to those who had responded to the earlier surveys. The data were analyzed using descriptive statistics such as chi-squared or Fisher's exact tests for categorical variables. The survey was sent to all Association of American Cancer Institutes cancer center members. In the first or second administration, 167 practitioners answered the survey; 31 responded to the third survey. RESULTS Three quarters of the providers did not favor the new requirement for IRCI and 62% encountered questions from patients about results being sent to them without provider interpretation. Only half of the hospitals had a plan in place to deal with the new IRCI requirements. A third survey, for longitudinal follow-up, indicated a more favorable trend toward adoption of IRCI. CONCLUSION IRCI for patients with cancer was perceived negatively by academic oncology providers after its implementation. It was viewed to be associated with higher levels of patient anxiety and complaints about the care delivered. Providers preferred to discuss test results with patients before release.
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Affiliation(s)
- P. Abena Anyidoho
- College of Education and Human Ecology, The Ohio State University, Columbus, OH
| | | | | | | | | | - Kendra Cameron
- Association of American Cancer Institutes, Pittsburgh, PA
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Leonard SM, Zackula R, Wilcher J. Attitudes and Experiences of Clinicians After Mandated Implementation of Open Notes by the 21st Century Cures Act: Survey Study. J Med Internet Res 2023; 25:e42021. [PMID: 36853747 PMCID: PMC10015345 DOI: 10.2196/42021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/13/2022] [Accepted: 01/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND On December 13, 2016, the US Congress enacted the 21st Century Cures Act (hereafter the Cures Act), which contained the Final Rule mandate that took effect on April 5, 2021. Since then, health systems have been required to provide patients digital access to their eHealth information "without delay" and without charge. OBJECTIVE This study aimed to assess clinicians' initial experiences with, and attitudes toward, sharing visit notes with patients after being mandated to do so by the Cures Act and to determine clinician preferences regarding instant record release. METHODS This cross-sectional survey study was conducted between June 10, 2021, and August 15, 2021, at the University of Kansas Health System, a large academic medical center in Kansas City, Kansas, United States. Participants included clinicians currently employed by the health system, including resident and attending physicians, physician assistants, nurse practitioners, and critical care and emergency medicine registered nurses. RESULTS A total of 1574 attending physicians, physician assistants, and nurse practitioners, as well as 506 critical care and emergency medicine nurses, were sent invitations; 538 (34.18%) and 72 (14.2%), respectively, responded. Of 609 resident physicians, 4 (response rate not applicable because it was unknown how many residents viewed the website while the link was available) responded. The majority of respondents were attending physicians (402/614, 65.5%) and within the department of internal medicine (160/614, 26.1%). Most agreed that sharing visit notes was a good idea (355/613, 57.9%) and that it is important to speak with the patients before they accessed their records (431/613, 70.3%). Those who agreed that sharing visit notes is a good idea tended to view the practice as a useful tool for engaging patients ("Agree": 139/355, 39.2%; "Somewhat agree": 161/355, 45.4%; P<.001) and experience no change in the clinical value of their notes for other clinicians (326/355, 91.8%; P<.001). Those who disagreed (or were neutral) tended not to encourage patients to read their notes (235/258, 91.1%; P<.001) and were more likely to experience a change in their charting practice (168/257, 65.4%; P<.001) and increased time charting (99/258, 38.4%; P<.001). CONCLUSIONS The findings of this study may be generalizable to institutions similar to the University of Kansas Health System, and the clinician testimonies gathered in this study may provide valuable insight into the initial opinions and experiences of clinicians at these institutions. In addition, these clinician experiences collected early in the transition period may be used to guide future health policy implementation and to understand how best to prepare clinicians for these changes in practice.
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Affiliation(s)
- Sophia M Leonard
- Kansas City Campus, The University of Kansas School of Medicine, Kansas City, KS, United States
| | - Rosalee Zackula
- Wichita Campus, Office of Research, The University of Kansas School of Medicine, Wichita, KS, United States
| | - Jonathan Wilcher
- Kansas City Campus, Department of Emergency Medicine, The University of Kansas Health System, Kansas City, KS, United States
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Blease C, Torous J, Dong Z, Davidge G, DesRoches C, Kharko A, Turner A, Jones R, Hägglund M, McMillan B. Patient Online Record Access in English Primary Care: Qualitative Survey Study of General Practitioners' Views. J Med Internet Res 2023; 25:e43496. [PMID: 36811939 PMCID: PMC9996425 DOI: 10.2196/43496] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/16/2022] [Accepted: 12/31/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In 2022, NHS England announced plans to ensure that all adult primary care patients in England would have full online access to new data added to their general practitioner (GP) record. However, this plan has not yet been fully implemented. Since April 2020, the GP contract in England has already committed to offering patients full online record access on a prospective basis and on request. However, there has been limited research into UK GPs' experiences and opinions about this practice innovation. OBJECTIVE This study aimed to explore the experiences and opinions of GPs in England about patients' access to their full web-based health record, including clinicians' free-text summaries of the consultation (so-called "open notes"). METHODS In March 2022, using a convenience sample, we administered a web-based mixed methods survey of 400 GPs in the United Kingdom to explore their experiences and opinions about the impact on patients and GPs' practices to offer patients full online access to their health records. Participants were recruited using the clinician marketing service Doctors.net.uk from registered GPs currently working in England. We conducted a qualitative descriptive analysis of written responses ("comments") to 4 open-ended questions embedded in a web-based questionnaire. RESULTS Of 400 GPs, 224 (56%) left comments that were classified into 4 major themes: increased strain on GP practices, the potential to harm patients, changes to documentation, and legal concerns. GPs believed that patient access would lead to extra work for them, reduced efficiency, and increased burnout. The participants also believed that access would increase patient anxiety and incur risks to patient safety. Experienced and perceived documentation changes included reduced candor and changes to record functionality. Anticipated legal concerns encompassed fears about increased litigation risks and lack of legal guidance to GPs about how to manage documentation that would be read by patients and potential third parties. CONCLUSIONS This study provides timely information on the views of GPs in England regarding patient access to their web-based health records. Overwhelmingly, GPs were skeptical about the benefits of access both for patients and to their practices. These views are similar to those expressed by clinicians in other countries, including Nordic countries and the United States before patient access. The survey was limited by the convenience sample, and it is not possible to infer that our sample was representative of the opinions of GPs in England. More extensive, qualitative research is required to understand the perspectives of patients in England after experiencing access to their web-based records. Finally, further research is needed to explore objective measures of the impact of patient access to their records on health outcomes, clinician workload, and changes to documentation.
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Affiliation(s)
- Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - John Torous
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Zhiyong Dong
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Catherine DesRoches
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Anna Kharko
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,School of Psychology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Andrew Turner
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom.,National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Ray Jones
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Maria Hägglund
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
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Development, implementation and evaluation of the digital transformation of renal services in Wales: the journey from local to national. Int J Clin Pharm 2023; 45:4-16. [PMID: 36306061 PMCID: PMC9614750 DOI: 10.1007/s11096-022-01466-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Treatment for people with kidney disease is often associated with complicated combinations of medicines. Logistical challenges with traditiona paper-based prescribing means that these patients are particularly susceptible to medication-relation errors and harm. AIM To improve the quality of care that people with kidney disease receive across Wales through a Value-Based digital transformation programme. SETTING Renal units within the National Welsh Renal Clinical Network (WRCN). DEVELOPMENT A novel Electronic Prescribing & Medicines Administration (EPMA) system, integrated into a patient care record and linked to a patient portal was developed in South West Wales (SWW) region of the WRCN, enabled by the Welsh Government (WG) Efficiency Through Technology Fund. National upscale was enabled through the WG Transformation Fund. IMPLEMENTATION EPMA was designed and rolled out initially in SWW region of the WRCN (2018). A dedicated delivery team used the blueprint to finalise and implement a strategy for successful national roll-out eventually across all Wales (completed 2021). EVALUATION A multi-factorial approach was employed, as both the technology itself and the healthcare system within which it would be introduced, were complex. Continuous cycles of action research involving informal and formal qualitative interviews with service-users ensured that EPMA was accessible and optimally engaging to all target stakeholders (patients and staff). Results confirmed that EPMA was successful in improving the quality of care that people with kidney disease receive across Wales, contributed to Value-Based outcomes, and put people who deliver and access care at the heart of transformation. CONCLUSION Key findings of this study align directly with the national design principles to drive change and transformation, put forward by the WG in their plan for Health and Social Care: prevention and early intervention; safety; independence; voice; seamless care.
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Lam BD, Dupee D, Gerard M, Bell SK. A Patient-Centered Approach to Writing Ambulatory Visit Notes in the Cures Act Era. Appl Clin Inform 2023; 14:199-204. [PMID: 36889340 PMCID: PMC9995217 DOI: 10.1055/s-0043-1761436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Affiliation(s)
- Barbara D. Lam
- Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - David Dupee
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, California, United States
| | - Macda Gerard
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts, United States
| | - Sigall K. Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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Kelly MM, Hoonakker PLT, Nacht CL, Smith CA, Dean SM, Sklansky DJ, Smith W, Sprackling CM, Zellmer BM, Coller RJ. Parent Perspectives on Sharing Pediatric Hospitalization Clinical Notes. Pediatrics 2023; 151:e2022057756. [PMID: 36450655 PMCID: PMC9998186 DOI: 10.1542/peds.2022-057756] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Federal guidelines mandate that hospitals provide patients and caregivers with free, online access to their physician's clinical notes. This study sought to identify parent perceptions of the benefits and challenges of real-time note access during their child's hospitalization and strategies to optimize note-sharing at the bedside. METHODS This qualitative study was conducted with parents of children aged <12 years admitted to a pediatric hospitalist service in April 2019. Parents were given access to their child's admission and daily progress notes on a bedside tablet (iPad), and interviewed upon discharge. In-depth, 60-minute interviews were audio-recorded and transcribed. Two researchers developed and refined a codebook and coded data inductively and deductively with validation by a third researcher. Thematic analysis was used to identify emergent themes. RESULTS The 28 interviewed parents described 6 benefits of having note access, which: provided a recap and improved their knowledge about their child's care plan, enhanced communication, facilitated empowerment, increased autonomy, and incited positive emotions. Potential challenges included that notes: caused confusion, hindered communication with the health care team, highlighted problems with note content, and could incite negative emotions. Parents recommended 4 strategies to support sharing: provide preemptive communication about expectations, optimize the note release process, consider parent-friendly note template modifications, and offer informational resources for parents. CONCLUSIONS Findings provide a framework for operationalizing note-sharing with parents during hospitalization. These results have important implications for hospitals working to comply with federal regulations and researchers assessing the effects of increased information transparency in the inpatient setting.
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Affiliation(s)
- Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, California
| | | | - Shannon M Dean
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel J Sklansky
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Carley M Sprackling
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Benjamin M Zellmer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Leung T, Agrawal L, Sharman R. The Role of Access Type and Age Group in the Breadth of Use of Patient Portals: Observational Study. J Med Internet Res 2022; 24:e41972. [PMID: 36574284 PMCID: PMC9832356 DOI: 10.2196/41972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/06/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Health care delivery and patient satisfaction are improved when patients engage with their medical information through patient portals. Despite their wide availability and multiple functionalities, patient portals and their functionalities are still underused. OBJECTIVE We seek to understand factors that lead to patient engagement through multiple portal functionalities. We provide recommendations that could lead to higher patients' usage of their portals. METHODS Using data from the Health Information National Trends Survey 5, Cycle 3 (N=2093), we performed descriptive statistics and used a chi-square test to analyze the association between the demographic variables and the use of mobile health apps for accessing medical records. We further fitted a generalized linear model to examine the association between access type and the use of portal functionalities. We further examined the moderation effects of age groups on the impact of access type on portal usage. RESULTS Our results show that accessing personal health records using a mobile health app is positively associated with greater patient usage of access capabilities (β=.52; P<.001), patient-provider interaction capabilities (β=.24, P=.006), and patient-personal health information interaction capabilities (β=.23, P=.009). Patients are more likely to interact with their records and their providers when accessing their electronic medical records using a mobile health app. The impacts of mobile health app usage fade with age for tasks consisting of viewing, downloading, and transmitting medical results to a third party (β=-.43, P=.005), but not for those involving patient-provider interaction (β=.05, P=.76) or patient-personal health information interaction (β=-.15, P=.19). CONCLUSIONS These findings provide insights on how to increase engagement with diverse portal functionalities for different age groups and thus improve health care delivery and patient satisfaction.
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Affiliation(s)
| | - Lavlin Agrawal
- State University of New York, University at Buffalo, Buffalo, NY, United States
| | - Raj Sharman
- State University of New York, University at Buffalo, Buffalo, NY, United States
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Kim ES. [Patient's Clinical User Experience in Gastroenterology]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:241-246. [PMID: 36567436 DOI: 10.4166/kjg.2022.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
As clinical practices change to involve patients more actively and patient feedback becomes integrated into ongoing measures of quality, patients themselves, along with their families and friends, could play a creative part in crafting solutions to improve patient's experience. We could convene focus groups of patients to help examine varied aspects of our practice, ranging from the flow through our offices to the way we communicate. They could work with us, helping us make choices and set priorities. Incorporating both patients' perceptions and suggestions for change can address clinically significant aspects of the patient experience, foster the involvement of patients in their care, and help assess and improve the quality of the care we deliver. The electronic medical record and secure patient portals increasingly provide a powerful opportunity to actively promote patient involvement. Improving of patient's experience can help doctors draw closer to their patients and restore and strengthen public trust. It can both improve the quality of our care and add to the joy of being a doctor. Our purpose is to improve patients' treatment results, and through this, to feel rewarding as a doctor as a professional and to continue working as a doctor. To this end, improving the doctor-patient relationship through improving patient experience can be a key factor.
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Affiliation(s)
- Eun Sun Kim
- Department of Gastroenterology, Korea University College of Medicine, Seoul, Korea
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43
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DesRoches C, Walker J, Delbanco T. US experience with transparent medical records should reassure doctors. BMJ 2022; 379:o2969. [PMID: 36593551 DOI: 10.1136/bmj.o2969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Jan Walker
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA
| | - Tom Delbanco
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA
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44
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Winder GS, Clifton EG. The 21st Century Cures Act and psychosocial electronic documentation in solid organ transplantation: Potential harms and practical strategies. Am J Transplant 2022; 22:2781-2785. [PMID: 35841261 PMCID: PMC10087815 DOI: 10.1111/ajt.17153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/21/2022] [Accepted: 07/13/2022] [Indexed: 01/25/2023]
Abstract
Recent health system initiatives and government legislation have enhanced electronic health information (EHI) sharing in the healthcare technology environment. These measures are favorably viewed by most patients and clinicians. The 21st Century Cures Act, whose final rules went into effect in the United States in 2021, prohibits information blocking practices except in the case of potential harm. The definition of such harm, particularly regarding psychosocial EHI, is unclear and little guidance has been published. No articles address the matter in solid organ transplantation (SOT) despite the crucial role of psychosocial data in organ allocation. This article describes the implications of patient and family access to psychosocial EHI in SOT, discusses potential mechanisms of harm, and suggests practical communication strategies relevant to clinicians of all disciplines to promote high quality care and favorable interactions with patients and families.
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Affiliation(s)
- Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin G Clifton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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45
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Rodríguez-Fernández JM, Loeb JA, Hier DB. It's time to change our documentation philosophy: writing better neurology notes without the burnout. Front Digit Health 2022; 4:1063141. [PMID: 36518562 PMCID: PMC9742203 DOI: 10.3389/fdgth.2022.1063141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/10/2022] [Indexed: 08/23/2023] Open
Abstract
Succinct clinical documentation is vital to effective twenty-first-century healthcare. Recent changes in outpatient and inpatient evaluation and management (E/M) guidelines have allowed neurology practices to make changes that reduce the documentation burden and enhance clinical note usability. Despite favorable changes in E/M guidelines, some neurology practices have not moved quickly to change their documentation philosophy. We argue in favor of changes in the design, structure, and implementation of clinical notes that make them shorter yet still information-rich. A move from physician-centric to team documentation can reduce work for physicians. Changing the documentation philosophy from "bigger is better" to "short but sweet" can reduce the documentation burden, streamline the writing and reading of clinical notes, and enhance their utility for medical decision-making, patient education, medical education, and clinical research. We believe that these changes can favorably affect physician well-being without adversely affecting reimbursement.
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Affiliation(s)
| | - Jeffrey A. Loeb
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
| | - Daniel B. Hier
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
- Department of Electrical and Computer Engineering, Missouri University of Science and Technology, Rolla, MO, United States
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46
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Chang S, Torous J. Open notes and broader parallels in digital health: a commentary on C. Blease's 'Sharing online clinical notes with patients'. JOURNAL OF MEDICAL ETHICS 2022; 49:jme-2022-108763. [PMID: 36424128 DOI: 10.1136/jme-2022-108763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Sarah Chang
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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47
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Blease C, McMillan B, Salmi L, Davidge G, Delbanco T. Adapting to transparent medical records: international experience with "open notes". BMJ 2022; 379:e069861. [PMID: 36410770 DOI: 10.1136/bmj-2021-069861] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Liz Salmi
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Tom Delbanco
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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48
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Unintended consequences of patient online access to health records: a qualitative study in UK primary care. Br J Gen Pract 2022; 73:e67-e74. [PMID: 36316163 PMCID: PMC9639599 DOI: 10.3399/bjgp.2021.0720] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 08/28/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Health systems are seeking to harness digital tools to promote patient autonomy and increase the efficiency of care worldwide. The NHS Long Term Plan created the right for patients to access 'digital first' primary care by 2023-2024, including online patient access to full medical records. AIM To identify and understand the unintended consequences of online patient access to medical records. DESIGN AND SETTING Qualitative interview study in 10 general practices in South West and North West England. METHOD Semi-structured individual interviews with 13 patients and 16 general practice staff with experience of patient online access to health records. RESULTS Online access generated unintended consequences that negatively impacted patients' understanding of their health care, with patients finding surprising or difficult to interpret information. Online access impacted GPs' documentation practices, such as when GPs pre-emptively attempted to minimise potential misunderstandings to aid patient understanding of their health care. In other cases, this negatively impacted the quality of the records and patient safety when GPs avoided documenting speculations or concerns. Contrary to assumptions that workload would be reduced, online access introduced extra work, such as managing and monitoring access, and taking measures to prevent possible harm to patients. CONCLUSION The unintended consequences described by both staff and patients show that, to achieve the intended consequences set out in NHS policy, additional work is necessary to prepare records for sharing and to prepare patients about what to expect. It is crucial that practices are adequately supported and resourced to manage the unintended consequences of online access, now that it is the default position. A table of potential unintended consequences and mitigation measures is provided to aid practice managers and clinicians implementing online access.
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Schwarz J, Esch T. [OpenNotes in mental health? Pro]. DER NERVENARZT 2022; 93:1163-1164. [PMID: 35913587 DOI: 10.1007/s00115-022-01357-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Julian Schwarz
- Hochschulklinik für Psychiatrie und Psychotherapie, Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Seebad 82/83, 15562, Rüdersdorf, Deutschland.
| | - Tobias Esch
- Fakultät für Gesundheit (Department für Humanmedizin), Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Universität Witten-Herdecke, Witten, Deutschland
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50
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van Velsen L, Ludden G, Grünloh C. The Limitations of User-and Human-Centered Design in an eHealth Context and How to Move Beyond Them. J Med Internet Res 2022; 24:e37341. [PMID: 36197718 PMCID: PMC9582917 DOI: 10.2196/37341] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022] Open
Abstract
Human-centered design (HCD) is widely regarded as the best design approach for creating eHealth innovations that align with end users’ needs, wishes, and context and has the potential to impact health care. However, critical reflections on applying HCD within the context of eHealth are lacking. Applying a critical eye to the use of HCD approaches within eHealth, we present and discuss 9 limitations that the current practices of HCD in eHealth innovation often carry. The limitations identified range from limited reach and bias to narrow contextual and temporal focus. Design teams should carefully consider if, how, and when they should involve end users and other stakeholders in the design process and how they can combine their insights with existing knowledge and design skills. Finally, we discuss how a more critical perspective on using HCD in eHealth innovation can move the field forward and offer 3 directions of inspiration to improve our design practices: value-sensitive design, citizen science, and more-than-human design. Although value-sensitive design approaches offer a solution to some of the biased or limited views of traditional HCD approaches, combining a citizen science approach with design inspiration and imagining new futures could widen our view on eHealth innovation. Finally, a more-than-human design approach will allow eHealth solutions to care for both people and the environment. These directions can be seen as starting points that invite and support the field of eHealth innovation to do better and to try and develop more inclusive, fair, and valuable eHealth innovations that will have an impact on health and care.
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Affiliation(s)
- Lex van Velsen
- eHealth Department, Roessingh Research and Development, Enschede, Netherlands.,Department of Communication Science, University of Twente, Enschede, Netherlands
| | - Geke Ludden
- Department of Design, Production and Management, University of Twente, Enschede, Netherlands
| | - Christiane Grünloh
- eHealth Department, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Systems and Signals group, University of Twente, Enschede, Netherlands
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